Provider Demographics
NPI:1538317862
Name:RIORDAN, MARY FRANK (MS CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANK
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4612
Mailing Address - Country:US
Mailing Address - Phone:262-691-2300
Mailing Address - Fax:262-691-2184
Practice Address - Street 1:321 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6214
Practice Address - Country:US
Practice Address - Phone:262-691-2300
Practice Address - Fax:262-691-2184
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI298-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42708000Medicaid